The Prevalence and Risk Factors of GERD Among Indonesian Medical Doctors

Background: Based on our knowledge, the study of gastrointestinal reflux disease (GERD) among certain profession has never been conducted. The aim of this study is to determine the prevalence and risk factors of GERD among Indonesian doctors. Methods: A consecutive study involving 515 doctors was conducted in October 2015. The GerdQ score was used to the diagnosis of GERD and determined its impact on daily life. All possible risk factors were also analysed. Results: A total of 515 subjects completed the questionnaire. The mean age of them was 41.37 ± 11.92 years old. Fifty-five percent of them were male and 60.6% general practitioners. The prevalence of GERD was 27.4% of which 21.0% was had GERD with low impact on daily life, and 6.4% was GERD with high impact on daily life. The statistically significant risk factors of GERD was found in age >50 y.o (p = 0.002; OR = 2.054), BMI >30 kg/m2 (p = 0.016; OR = 2.53), and smokers (p = 0.031; OR = 1.982). Sex and education level were not found significant statistically as the risk factors of GERD. Conclusions: The prevalence of GERD among Indonesian physician was 27.4%. We found that age over 50 y.o, obesity and smoking habit were the risk factors of GERD in Indonesian doctors.&nbsp

Foregut microbiome in development of esophageal adenocarcinoma

Esophageal adenocarcinoma (EA), the type of cancer linked to heartburn due to gastroesophageal reflux diseases (GERD), has increased six fold in the past 30 years. This cannot currently be explained by the usual environmental or by host genetic factors. EA is the end result of a sequence of GERD-related diseases, preceded by reflux esophagitis (RE) and Barrett’s esophagus (BE). Preliminary studies by Pei and colleagues at NYU on elderly male veterans identified two types of microbiotas in the esophagus. Patients who carry the type II microbiota are >15 fold likely to have esophagitis and BE than those harboring the type I microbiota. In a small scale study, we also found that 3 of 3 cases of EA harbored the type II biota. The findings have opened a new approach to understanding the recent surge in the incidence of EA. 

Our long-term goal is to identify the cause of GERD sequence. The hypothesis to be tested is that changes in the foregut microbiome are associated with EA and its precursors, RE and BE in GERD sequence. We will conduct a case control study to demonstrate the microbiome disease association in every stage of GERD sequence, as well as analyze the trend in changes in the microbiome along disease progression toward EA, by two specific aims. Aim 1 is to conduct a comprehensive population survey of the foregut microbiome and demonstrate its association with GERD sequence. Furthermore, spatial relationship between the esophageal microbiota and upstream (mouth) and downstream (stomach) foregut microbiotas as well as temporal stability of the microbiome-disease association will also be examined. Aim 2 is to define the distal esophageal metagenome and demonstrate its association with GERD sequence. Detailed analyses will include pathway-disease and gene-disease associations. Archaea, fungi and viruses, if identified, also will be correlated with the diseases. A significant association between the foregut microbiome and GERD sequence, if demonstrated, will be the first step for eventually testing whether an abnormal microbiome is required for the development of the sequence of phenotypic changes toward EA. If EA and its precursors represent a microecological disease, treating the cause of GERD might become possible, for example, by normalizing the microbiota through use of antibiotics, probiotics, or prebiotics. Causative therapy of GERD could prevent its progression and reverse the current trend of increasing incidence of EA

Hiatoplasty with crura buttressing versus hiatoplasty alone during laparoscopic sleeve gastrectomy

Introduction. In obese patients with hiatal hernia (HH), laparoscopic sleeve gastrectomy (LSG) with cruroplasty is an option but use of prosthetic mesh crura reinforcement is debated. The aim was to compare the results of hiatal closure with or without mesh buttressing during LSG. Methods. Gastroesophageal reflux disease (GERD) was assessed by the Health-Related Quality of Life (GERD-HRQL) questionnaire before and after surgery in two consecutive series of patients with esophageal hiatus ≤ 4 cm2. After LSG, patients in group A (12) underwent simple cruroplasty, whereas in group B patients (17), absorbable mesh crura buttressing was added. Results. At mean follow-up of 33.2 and 18.1 months for groups A and B, respectively (p = 0 006), the mean preoperative GERD-HRQL scores of 16.5 and 17.7 (p = 0 837) postoperatively became 9.5 and 2.4 (p = 0 071). In group A, there was no difference between pre- and postoperative scores (p = 0 279), whereas in group B, a highly significant difference was observed (p = 0 002). The difference (Δ) comparing pre- and postoperative mean scores between the two groups was significantly in favor of mesh placement (p = 0 0058). Conclusions. In obese patients with HH and mild-moderate GERD, reflux symptoms are significantly improved at medium term follow-up after cruroplasty with versus without crura buttressing during LSG.Introduction. In obese patients with hiatal hernia (HH), laparoscopic sleeve gastrectomy (LSG) with cruroplasty is an option but use of prosthetic mesh crura reinforcement is debated. The aim was to compare the results of hiatal closure with or without mesh buttressing during LSG. Methods. Gastroesophageal reflux disease (GERD) was assessed by the Health-Related Quality of Life (GERD-HRQL) questionnaire before and after surgery in two consecutive series of patients with esophageal hiatus ≤ 4 cm2. After LSG, patients in group A (12) underwent simple cruroplasty, whereas in group B patients (17), absorbable mesh crura buttressing was added. Results. At mean follow-up of 33.2 and 18.1 months for groups A and B, respectively (p = 0 006), the mean preoperative GERD-HRQL scores of 16.5 and 17.7 (p = 0 837) postoperatively became 9.5 and 2.4 (p = 0 071). In group A, there was no difference between pre- and postoperative scores (p = 0 279), whereas in group B, a highly significant difference was observed (p = 0 002). The difference (Δ) comparing pre- and postoperative mean scores between the two groups was significantly in favor of mesh placement (p = 0 0058). Conclusions. In obese patients with HH and mild-moderate GERD, reflux symptoms are significantly improved at medium term follow-up after cruroplasty with versus without crura buttressing during LSG

Dietary guideline adherence for gastroesophageal reflux disease.

BackgroundGastroesophageal reflux disease (GERD) is the most common gastrointestinal disease, and the cost of health care and lost productivity due to GERD is extremely high. Recently described side effects of long-term acid suppression have increased the interest in nonpharmacologic methods for alleviating GERD symptoms. We aimed to examine whether GERD patients follow recommended dietary guidelines, and if adherence is associated with the severity and frequency of reflux symptoms.MethodsWe conducted a population-based cross-sectional study within the Kaiser Permanente Northern California population, comparing 317 GERD patients to 182 asymptomatic population controls. All analyses adjusted for smoking and education.ResultsGERD patients, even those with moderate to severe symptoms or frequent symptoms, were as likely to consume tomato products and large portion meals as GERD-free controls and were even more likely to consume soft drinks and tea [odds ratio (OR) = 2.01 95% confidence interval (CI) 1.12-3.61; OR = 2.63 95% CI 1.24-5.59, respectively] and eat fried foods and high fat diet. The only reflux-triggering foods GERD patients were less likely to consume were citrus and alcohol [OR = 0.59; 95% CI: 0.35-0.97 for citrus; OR = 0.41 95% CI 0.19-0.87 for 1 + drink/day of alcohol]. The associations were similar when we excluded users of proton pump inhibitors.ConclusionsGERD patients consume many putative GERD causing foods as frequently or even more frequently than asymptomatic patients despite reporting symptoms. These findings suggest that, if dietary modification is effective in reducing GERD, substantial opportunities for nonpharmacologic interventions exist for many GERD patients

2. Wochenbericht POS350

Die 350. Forschungsfahrt des FS POSEIDON fand vom 26. April bis 10. Mai 2007 unter der Fahrtleitung von Dr. Gerd Krahmann stat

Gastroesophageal reflux disease and tooth erosion

The increasing prevalence of gastroesophageal reflux disease (GERD) in children and adults, and of “silent refluxers” in particular, increases the responsibility of dentists to be alert to this potentially severe condition when observing unexplained instances of tooth erosion. Although gastroesophageal reflux is a normal physiologic occurrence, excessive gastric and duodenal regurgitation combined with a decrease in normal protective mechanisms, including an adequate production of saliva, may result in many esophageal and extraesophageal adverse conditions. Sleep-related GERD is particularly insidious as the supine position enhances the proximal migration of gastric contents, and normal saliva production is much reduced. Gastric acid will displace saliva easily from tooth surfaces, and proteolytic pepsin will remove protective dental pellicle. Though increasing evidence of associations between GERD and tooth erosion has been shown in both animal and human studies, relatively few clinical studies have been carried out under controlled trial conditions. Suspicion of an endogenous source of acid being associated with observed tooth erosion requires medical referral and management of the patient as the primary method for its prevention and control.Sarbin Ranjitkar, John A. Kaidonis, and Roger J. Smale

Complete Mouth Rehabilitation and Gastroesophageal Reflux Disease: Conventional and Contemporary Treatment Approaches

This report describes the diagnosis and prosthodontic management of 2 patients with a history of chronic gastroesophageal reflux disease and worn dentition. Different treatment approaches were used for oral rehabilitation. Use of conventional and contemporary restorative materials resulted in functional and esthetic prosthodontic rehabilitation with a favorable prognosis. Gastroesophageal reflux disease (GERD) is a “condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Reflux episodes can be intensified by dietary habits, smoking, physical exercise, and obstructive sleep apnea.Complications of GERD are regurgitation, chest pain, esophagitis, Barrett’s esophagus, esophageal adenocarcinoma, cough, asthma, and dental erosion.GERD is associated with dental erosion and sleep bruxism,and dental erosion may be the only symptom of GERD. The purpose of this report was to present the oral diagnosis and management of 2 patients with chronic GERD who presented with tooth wear and required complete mouth rehabilitation. The restoration of dentition was achieved by following different treatment modalities

The Role of Pepsinogenes and Some Intestinal Hormones in Pathogenesis of Gastroesophageal Reflux Disease

80 patients with gastroesophageal reflux disease (GERD) were examined. The diagnosis of GERD was based on the history of the disease, complaints of patients, the results of daily monitoring of pH in the lower third of the esophagus, data of fibroesophagogastroduodenoscopy, chromoendoscopy, 13C-octanoic breath test, gastrin-17 (G-17) concentration, pepsinogens I and II (P I and II) and cholecystokinin-pancreozymin (C-P) in serum.After 24 hours pH monitoring of the lower third of the esophagus in 40 patients with GERD, the predominance of acid was found, and the other 40 patients had mixed refluxes. In patients with predominance of acid reflux, the mean values of half-life of solid food evaluation (T1/2) according to 13C-octanoic breath test was (45.25±1.34) min. With the predominance of mixed refluxes in patients, there was a tendency towards hypokinetic motility of the stomach, indicating a slowdown in half-life of solid food evaluation from the stomach up to (139.24±11.87) min. With the predominance of acid reflux also was observed a significant reduction in the concentration of G-17 and C-P, an increase in P I and a decrease in the concentration of P II. Hypergastrinemia, high levels of C-P and P II (37.44±3.41) μg/l (p<0,05) were diagnosed with the predominance of mixed refluxes

HUBUNGAN OBESITAS TERHADAP KEJADIAN GASTROESOPHAGEAL REFLUX DISEASE (GERD) DI RSUD DR. ZAINOEL ABIDIN BANDA ACEH

ABSTRAKGastroesophageal Reflux Disease (GERD) terjadinya kerusakan esofagus yang diakibatkan oleh refluknya isi lambung ke esofagus. Diyakini peningkatan kejadian GERD dipengaruhi salah satunya obesitas, dikarenakan memiliki intra adominal dan intra gaster lebih tinggi dibandingkan dengan Indeks Massa Tubuh normal. Penelitian ini bertujuan untuk mengetahui hubungan obesitas terhadap kejadian GERD. Desain penelitian ini adalah analitik cross-sectional. Responden penelitian adalah 54 orang. Responden diambil dengan metode non-probability sampling, yaitu secara accidental sampling. Selanjutnya data dianalisis dengan menggunakan uji Chi-Square. Penelitian memperoleh data responden yang obesitas dan mengalami GERD 74,9% sedangkan jumlah responden yang tidak obesitas mengalami GERD 45%. Hasil analisis data menunjukan p value sebesar 0,01. Kesimpulan dari penelitian, terdapat hubungan obesitas terhadap kejadian GERD di Rumah Sakit Umum dr. Zainoel Abidin Banda Aceh.Kata kunci : Gastroesophageal Reflux Disease (GERD), ObesitasABSTRACTGastroesophageal Reflux Disease (GERD) is a condition which can damage the esophagus due to the reflux of gastric contents. GERD is more common in obesity due to increasing of intraabdominal and intra gastric pressure compare to in those with normal Body Mass Index. The aim of this study was to assess the association betwen obesity and GERD. This was an analitical cross sectional study involving 54 outpatients. Subjects was chose by accidental sampling method. Data was analyzed using chi square test. The pravalence of GERD was 74,9% in those with obese and 40% inthose without obese. Chi-square test showed the p value is 0,01. In conclution, the current study showed a relation between obesity and GERD in General Hospital of Zainoel Abidin Banda Aceh.Keywords : Gastroesophageal Reflux Diease (GERD), Obesit

HUBUNGAN GEJALA GASTROESOPHAGEAL REFLUX DISEASE (GERD) DENGAN TINGKAT KONTROL ASMA DI POLIKLINIK PARU RUMAH SAKIT UMUM ZAINOEL ABIDING BANDA ACEH PERIODE SEPTEMBER-OKTOBER 2014

ABSTRAKLatarBelakang: Menurut Global Initiative for Asthma (GINA) tahun 2014 bahwa asma merupakan penyakit kronik saluran pernapasan yang mempengaruhi 1-18% penduduk, bervariasi diberbagai negara. Serangan asma bronkial dapat dipengaruhi oleh beberapa faktor salah satunya adalah gastroesophageal reflux disease (GERD). Hubungan antara GERD dan asma pertama kali dikemukakan oleh Sir William Osler pada tahun 1892. GERD berhubungan dengan asma bronkial terutama pada asma yang tidak terkontrol. Tingkat kontrol asma lebih mengarah kepada upaya pengendalian gejala klinik penyakit termasuk perbaikan fungsi paru. Tujuan penelitian ini adalah untuk mengetahui hubungan gejala GERD dengan tingkat kontrol asma pada penderita asma bronkial di Poli Paru RSUDZA Banda Aceh periode September sampai Oktober 2014.Metode: Jenis penelitian ini adalah analitik observasional dengan pendekatan cross sectional. Pengambilan data dilakukan pada bulan September sampai Oktober 2014. Pengambilan data menggunakan teknik non probability sampling dengan menggunakan consecutive sampling pada 59 responden penderita asma bronkial. Data dikumpulkan melalui kuesioner GERDQ untuk menilai gejala GERD dan kuesioner ACT untuk menilai tingkat kontrol asma kemudian hasil penelitian dianalisis menggunakan uji Chi-Square.Hasil: Gejala GERD pada penderita asma yang tidak terkontrol yaitu sebanyak 32 responden (54,2%), sedangkan gejala GERD pada penderita asma terkontrol sebagian adalah sebanyak 4 responden (6,8%). Penderita asma yang tidak mengalami gejala GERD dan mempunyai asma tidak terkontrol adalah sebanyak 11 responden (18,6%), sedangkan penderita asma yang tidak mengalami GERD dan memiliki kontrol asma sebagian adalah sebanyak 12 responden (20,3%).Simpulan: Terdapat hubungan yang bermakna antara gejala GERD dengan tingkat kontrol asma pada penderita asma bronkial di Poli Paru RSUDZA Banda Aceh periode September sampai Oktober 2014 (P=0,001). Gejala klinis GERD yang paling sering dialami penderita asma adalah regurgitasi yaitu sebanyak 31 responden (86,1%).Kata Kunci: Gejala GERD, tingkat kontrol asma, asma bronkia